Healthcare Provider Details

I. General information

NPI: 1194706382
Provider Name (Legal Business Name): DAVIDSON SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 LEXINGTON AVE SUITE A
THOMASVILLE NC
27360-2870
US

IV. Provider business mailing address

1219 LEXINGTON AVE SUITE A
THOMASVILLE NC
27360-2870
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-7148
  • Fax: 336-475-7031
Mailing address:
  • Phone: 336-475-7148
  • Fax: 336-475-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39915
License Number StateNC

VIII. Authorized Official

Name: DR. MARK D SMITH, II
Title or Position: CORPORATE PRESIDENT
Credential: M.D.
Phone: 336-475-7148